Resource Pages

Fatigue

July 26, 2007

Fibromyalgia is a chronic, widespread pain in muscles and soft tissues accompanied by fatigue, it is a fairly common condition, affecting 3% to 6% of the general population, and is most commonly diagnosed in people between the ages of 20 and 50, though onset can occur in
childhood. The disease is not life-threatening, though the degree of
symptoms may vary greatly from day to day with periods of flares
(severe worsening of symptoms) or remission. The syndrome is generally
perceived as non-progressive, yet that issue is still a matter of debate.

The cardinal symptoms of fibromyalgia are chronic, widespread pain and
tenderness to light touch together with moderate to severe fatigue.
Those affected may also experience heightened sensitivity of the skin ("allodynia"),
tingling of the skin that is often needle-like, a deep ache in the muscle and , less often, the tendons, prolonged muscle spasms, weakness in the limbs, and nerve pain.
Chronic sleep disturbances are also characteristic of fibromyalgia, and
some studies suggest that these sleep disturbances are the result of a
sleep disorder called alpha-delta sleep , a condition in which
deep sleep (associated with delta EEG waves) is frequently interrupted
by bursts of brain activity similar to wakefulness (i.e. alpha waves).
Deeper stages of sleep (stages 3 & 4) are often dramatically
reduced, and that is the likely cause of the cognitive problems that so often accompany fibromyalgia.

There is not any structural damage in an organ, though it may sometimes start after trauma, such as a motor vehicle accident.

It is that last fact, that there is s often no obvious physical pathology, that has lead so many people to claim that fibromyalgia is “nothing more than” pain associated with depression. I have has some interesting “discussions” with health care professionals convinced that people wit fibromyalgia do not have a “real” illness, and that they need psychotherapy or antidepressants. Yet pain is pain, and the false dichotomy: “Is the pain my mind or in my body?” helps nobody.

Twenty-five years ago, Muhammad B. Yunus and his collaborators published the first controlled study of the clinical characteristics of fibromyalgia syndrome. That seminal article, published in Seminars in Arthritis and Rheumatism, led directly to formal recognition of this disease by the medical community. Last month, again in Seminars in Arthritis and Rheumatism, Muhammed makes another enormous contribution to the field of chronic pain and fatigue by meticulously synthesizing and interpreting the extensive body of scientific literature on fibromyalgia and his own insights into the concept of central sensitivity syndromes (CSS) that include irritable bowel syndrome, migraine and restless legs syndrome.

In fact there are at least 13 separate conditions that are related to central sensitization (CS), where the central nervous system becomes extremely sensitized with respect to certain parts of the body, so that even mild pressure or touch would cause much pain. This hypersensitivity may also be associated with other symptoms such as poor sleep and fatigue.

Muhammed took a rather more biological approach to fibromyalgia in the past, now emphasizes a biopsychosocial perspective:

“In my view, this is tremendously important because it is the only way to synthesize the disparate contributions of such variables as genes and adverse childhood experiences, life stress and distress, posttraumatic stress disorder, mood disorders, self-efficacy for pain control, catastrophizing, coping style, and social support into the evolving picture of central nervous system dysfunction vis-à-vis chronic pain and fatigue. Science and medicine now have rational scaffolding for understanding and treating chronic pain syndromes previously considered to be 'functional' or 'unexplained.' Neuroscience research will continue to reveal the mechanisms of CS, but only if informed through a biopsychosocial perspective and with the interdisciplinary collaboration of basic scientists, psychologists, sociologists, epidemiologists, and clinicians."

One of the reasons that I so like this new version of his model is because it fits so well with the concept of “Salience Disruption Syndrome.” A fancy name for a common problem that I talk about in Healing, Meaning and Purpose.

So very many people are super-sensitive to the environment and also have trouble in filtering out and deciding what is important. As a result pain, attentional problems, impulse control disorders, addictions and several other things tend to cluster together.

Happily we now have an array of novel techniques for dealing with these problems, and I plan to put out more books and papers on ways in which we can help.

February 09, 2007

You will not find them listed on WebMD, but “Diseases of Discipleship” are nonetheless very real. I have mentioned them in Healing Meaning and Purpose and also here. They are the result of sudden access to spiritual energies that can upset the balance of the body, mind and spirit. The great value of having a teacher is to help you balance and work with these energies without being harmed by them.

I have also had a great deal of experience with people undergoing spiritual crises. Many have been referred to me by priests, clergy and intuitives, because many of the individuals thought that they were “going crazy,” and some had ben given psychiatric diagnoses. That extensive experience has helped me and some of my students to describe some of the “symptoms” in more detail.

Roberto Assagioli identified five critical points where problems may arise:

Many begin to feel and see their own Inner Light and the Inner Light of other people

Not everyone gets all of these symptoms and they may come and go for a while. Some people don't get any at all, but they are unusual. There are twobooks by Hazel Courteney that detail some of what happened to her, and they are well worth a read.

It is important to emphasize that all of these signs and symptoms can also be caused by illnesses. So although most people who are going through all this want to avoid doctors, it is a very good idea to ensure that everything is okay. I once saw someone who had been told that she was having a kundalini experience, even though she did not have any of the usual features. She became very unwell, but felt much better when an insulin-producing tumor was removed from her pancreas.

The most important thing is to help people remain grounded. I have seen many people become extremely grandiose and even fanatical after going through a rapid spiritual awakening. It is also important to ensure that any physical symptoms - such as thyroid or blood pressure problems - do not continue unchecked.

Helping people who are going through spiritual change or crisis needs the help of a person or persons who understand physical and psychological problems, as well as being some way along the path of spiritual development. By “crisis” I do not mean crisis of faith, but a critical turning point in an individual’s personal development.

There are plenty of good ways of grounding using some physical, psychological and subtle system exercises. I have dozens of excellent techniques that I can publish if you are interested. Sometimes it is also a good idea to eat some heavy food.

It can be very helpful to get away form other people for a while. This doesn’t mean becoming a monk or nun, but just to avoid a bad case of people poisoning. In their overly sensitive state they can pick up a lot of negative things from the people around them. I have known a good many people who would begin to experience all the physical and psychological symptoms of the people around them.

Once we have confirmed that the person does not have all this as a result of thyroid disease or anxiety, it is essential to show them what is going on and the best way to approach and conceptualize it.

Next we help people to control some of the impulses that can otherwise swamp them. One of the many reasons for development of the sophisticated mind control techniques developed by Tibetan Buddhism was to help people watch their spiritual unfoldment without being overwhelmed by it.

We also try to help people to transmute psychological energies so that they can be used constructively.

Everybody is different, but in some people acupuncture, qigong, Reiki and homeopathy have all been helpful. Several of the flower essences can be very useful, in particular:VervainStar TulipWhite YarrowPink Yarrow

Every expert that I know in the field of spiritual development agrees with my observation that there are currently more people having major spiritual changes than ever before. It is essential for us all to know how to protect, support and birth them.

“To penetrate into the essence of all being and significance, and to release the fragrance of that inner attainment for the guidance and benefit of others, by expressing in the world of forms - truth, love, purity and beauty - this is the sole game that has any intrinsic and absolute worth. All other incidents and attainments can, in themselves, have no lasting importance.”--Meher Baba (Indian Spiritual Teacher who, from July 1925 maintained Silence, 1894-1969)

“You knock at the door of Reality. You shake your thought wings, loosen your shoulders, and open.”--Jalal al-Din Rumi (Afghan Sufi Poet, 1207-1273)“Life is a series of awakenings.”--Sri Swami Sivananda (Indian Physician and Spiritual Teacher, 1887-1963)“What we usually call human evolution is the awakening of the Divine Nature within us.”--“Peace Pilgrim” (a.k.a. Mildred Norman, American Peace Activist, 1908-1981)

December 31, 2006

I get to hear about a great many medical and psychological problems in people in the public eye. But after 30+ years in medicine, I don't talk about them. That's obvious if someone is my patient: everything is completely confidential. But I also will not talk about medical problems in other people, unless they volunteer information.

Many of us have been very concerned over the physical health of the philosopher Ken WIlber.

In August I posted a brief note after he had taken a nasty tumble. I also pointed out that many of his problems with chronic fatigue syndrome could also be re-framed as "Diseases of Discipleship." Based on that, I made some predictions about other possible symptoms.

Ken has now written an extraordinarily important piece, after he suffered from a series of grand mal epileptic seizures at the beginning of December. I had heard about these problems, but would not post anything until Ken did. Even when I saw some really silly comments about the causes of his problems!

There has been speculation for many years now that many shamans had epilepsy or occasional epileptic seizures. There is also an association between one type of epilepsy and hyper-religiosity.

If you have any interest in the deeper meaning of chronic illness, the spiritual path and karma, I urge you to take a few moments to read Ken's article.

He also mentions a website with more information about the whole Myalgic Encephalomyelitis/Chronic Fatigue complex. I have checked the out, and I agree that this is a most helpful resource.

November 05, 2006

Do you ever see that episode of the original Star Trek in which Spock is accidentally – and temporarily – blinded when he is exposed to ultra-bright light to drive out a parasite? For people who like to know such things, it was episode 29, entitled Operation: Annihilate!

In the end it turns out that he only needed to have been exposed to one invisible wavelength of light. Naturally enough, being Star Trek it all comes out all right in the end.

I was reminded of this as I examined some extraordinarily important recent research from Thomas Jefferson University in Philadelphia. We have known for a long time that light is an effective treatment for seasonal affective disorder (SAD). However, until now, nobody has been able to determine the best wavelength to use. This new research found that the most effective wavelength was blue. It is thought that blue light therapy may help a great many more things than SAD.

SAD is one of a group of disorders involving our circadian rhythms. Many experts are currently trying to establish the relationship between SAD and another major disturbance of circadian rhythms: bipolar disorder. They are certainly not the same thing, but they are closely related to each other. Some other circadian rhythm disturbances that may respond to blue light are sleep disturbances, jet lag, sleepiness during shift work and spaceflight.

It has always been assumed that the brain’s major pacemaker – the suprachiasmatic nucleus (SCN) – only responded to bright light at a certain time of day. The SCN regulates the production of melatonin by the pineal gland. The fact that lower-intensity blue light is more effective than the most visible kinds of light is part of a body of evidence that there is a separate photoreceptor system within the human eye. The system that resets the body clock to the 24-hour day is different from the rods and cones used in regular vision.

In linked research by the same investigators, as well as a team from and Brigham and Women’s Hospital and Harvard Medical School in Boston, blue light was shown to directly reduce sleepiness. People exposed to blue light were able to sustain a high level of alertness during the night when people usually feel most sleepy. The results suggest that light may be a powerful countermeasure for the negative effects of fatigue for people who work at night.

There is more to this research: breast cancer is linked to fluctuations in human circadian rhythms, with higher rates in industrialized countries where there is a great deal of exposure to artificial light at night. It has been suggested that melatonin may be a link between artificial light and breast cancer. Blue light may perhaps mitigate some of the effects of light on suppressing melatonin.

There is another point to be made here. Many people teach techniques of being able to see the human aura. Many of the techniques of the “See the aura in 30 seconds” type, are no more than visual illusions. But there is another group of techniques that involves the use of peripheral vision to gradually become aware of the fields around people, animals and plants. By a strange "conincidence" the ancients identified the pineal gland with the "third eye." Have the researchers inadvertently found a biological mechanism for seeing auras?“Sleeplessness is a desert without vegetation or inhabitants.”--Jessamyn West (American Writer, 1902-1984)

October 16, 2006

Dehydroepiandrosterone (DHEA) is a hormone that has attracted a lot of attention. It’s launched hundreds of websites, product lines and a few books and magazine articles. So what’s all the fuss about, and should we all be chomping down on DHEA tablets?

DHEA is manufactured at several sites in the body, but by far the most important is in one of the outer layers of the adrenal gland. Like all the steroid hormones it is made from cholesterol. It has various protective effects in the body, regulates some enzyme systems, can be converted to estrogen and under certain circumstances to testosterone. It has very weak androgen (male hormone) activity.

In cell culture it has a lot of other actions too, but it is always difficult to jump from effects seen using large doses in isolated cells, to giving advice on what supplements people should be taking.

There has been a lot of talk about the possibility that some people may, as a result of stress or toxins, suffer from exhaustion of the adrenal glands. There is a great long list of symptoms that may be caused by this so-called adrenal fatigue, deficiency or insufficiency: the terms are often – and incorrectly – used interchangeably. And therein lies the problem. It is such a long list that it is non-specific. It’s always a bit of a worry when someone tells me that dozens of different symptoms are all caused by one single biochemical problem. That just isn’t the way that the human body works.

I have seen and treated countless people with a condition known as Addison’s disease: true chronic adrenal insufficiency. It can be a very serious illness and it is quite different from the “adrenal fatigue” that people talk about in some popular books. People with chronic fatigue syndrome do have lower levels of activity in what is known as the hypothalamic-pituitary-adrenal axis, but it is not because the adrenal glands are not working properly, but because the hypothalamus in the brain is not doing it’s job properly. There’s also no proven link between “burnout” and adrenal function.

During my years as an endocrinologist and holistic physician, I’ve spent a great deal of time looking for adrenal fatigue in sick people and I’ve never found it. I’ve done all the tests recommended by proponents of adrenal fatigue and adrenal insufficiency and when we’ve done the tests properly, we’ve drawn a blank. There are a great many parallels between the adrenal insufficiency story, and the old - and discredited - myth about people becoming unwell because of a thyroid deficiency that cannot be picked up on standard thyroid function tests.

So can DHEA do you any good? Or can it be harmful? What exactly is the evidence?

There is a comprehensive study, called The Dehydroepiandrosterone And WellNess (DAWN) study that should give us some solid answers as to the risks and benefits of DHEA. I shall post details of the findings as they become available. But some things we know already:

DHEA has been touted as an anti-aging supplement. But in a two-year prospective study done in older people attending the Mayo Clinic in Rochester, Minnesota, neither DHEA nor low-dose testosterone replacement had physiologically relevant beneficial effects on body composition, physical performance, insulin sensitivity, or quality of life. Perhaps the people in the study didn’t get enough DHEA, but it doesn’t look that way. Instead it seems that just giving the supplement doesn’t seem to do very much. But there is increasing evidence that 50-100mg of DHEA each day will improve muscle strength and muscle mass in older people who are doing strength training. Once again, it does nothing in people who are not exercising. Sorry!

According to the results of a small placebo-controlled, randomized trial published in the Archives of General Psychiatry, DHEA can be effective for midlife-onset minor and major depression. The study was conducted the National Institute of Mental Health Midlife Outpatient Clinic. In the trial, 23 men and 23 women aged 45 to 65 years with midlife-onset major or minor depression were randomized to six weeks of DHEA therapy, 90 mg/day, for three weeks and 450 mg/day for three weeks or to six weeks of placebo followed by six weeks of the other treatment. The subjects did not receive any other antidepressant medications during the study. Both of the doses of DHEA helped improve depression: there was no advantage in going to a higher dose, and there was no difference in the treatment response of men and women. The trouble with this study was not just the small size and the short duration, but the DHEA was not compared against a standard antidepressant. So we are still in the dark as to how effective it really is. It’s nice that it’s better than placebo, but this is just the first step in a larger research program.

A study from Taiwan indicated that people with higher levels of DHEA sulfate had a lower overall mortality over a three-year period. That is interesting, but absolutely does NOT mean that artificially increasing our levels of DHEA with supplements will make us live forever: we don’t yet have that kind of magic bullet.

In mice, quite large amounts of DHEA have the effect of slightly reducing the normal increase in stiffness of the left ventricle that can happen as animals get older. We have no idea whether something similar might help in humans, and the amounts of DHEA involved may rule it out as a viable treatment in people.

50mg/day improves subjective wellness in people who have no active pituitary gland. A rare condition, and we cannot use this evidence to advise healthy people about what to take.

Because DHEA is converted into estrogen and/or testosterone, it may have the potential to exacerbate or initiate hormone-responsive tumors. The evidence is not strong one way or the other, but it remains a worry. I don’t think that anyone recommends DHEA to people who have a personal or family history of breast or prostate cancer.

There is a BIG literature on DHEA. But my current conclusions from all this?

50-100mg of DHEA is probably worth trying if you are over 50 years of age and doing regular exercise.

It may help a bit with mild depression.

It should not be used in people with a personal or family history of breast, prostate or any other type of hormone-sensitive cancer.

August 06, 2006

I was very sorry to hear that Ken Wilber, whose work I admire enormously, has recently been very unwell. While weakened by an underlying chronic illness, he took a nasty fall that has left him pretty badly bruised, and with some possible neurological problems. Fortunately he is already somewhat better.

According to Ken, his underlying illness is a form of chronic fatigue syndrome called or caused by RNase-L Enzyme Dysfunction. People with the problem develop a number of bizarre symptoms apart from fatigue, including muscle weakness, fevers and immune dysfunction. The RNase enzyme is normally activated when a cell has to deal with viruses, some toxins and some bacteria. There is a good introduction here.

There is a growing literature on the subject: investigators from Brussels have recently shown a link between exercise performance and immune dysfunction in some of these patients. It may be that elevated RNase-L enzyme activity may provide us with a biological marker for some cases of chronic fatigue syndrome. Despite this research, I still have many colleagues who continue to say that chronic fatigue syndrome and a probably related condition, Chronic Fatigue and Immune Dysfunction Syndrome, are purely psychological problems.

I am quite sure that they are wrong.

Not least because there are very few illnesses that can be reduced to just psychological or just physical causes. These artificial distinctions do little to help people suffering with genuine problems. (You may be interested to have a look at a brief piece that I wrote about this artificial distinction.)

I do know that the most difficult problems that I have ever faced in clinical practice have been the chronic fatigue syndromes and a possibly related problem: interstitial cystitis. The only things that have helped have been approaches employing the five dimensional approach: physical, psychological, social, subtle and spiritual.

And now I’m going to go out on a limb and do something that normally I do not. I will normally not make even the broadest comments about someone’s diagnosis and treatment unless I’ve seen them myself: there are few things worse than people trying to diagnose at long range and when they only have half the information. But when I see symptoms like these: fatigue and fever, physical weakness and sometimes profound psychological effects, I have to ask whether the biochemical markers are actually telling us something different: that some people with these problems may actually have what used to be known as “diseases of discipleship.” An old-fashioned term used to describe some of the physical challenges and changes that may accompany spiritual evolution. If I am correct, I would predict that Ken - and many other sufferers - should also have profound disturbances of their normal circadian rhythms, some predictable but subtle endocrine disturbances, and otherwise inexplicable sensations roughly corresponding to the channels identified in Chinese and Ayurvedic medicine.

One of the most startling recent discoveries in medicine has been that some of the time-honored laws of healing are changing, because we are ourselves changing very rapidly. In Healing, Meaning and Purpose, I spent a long time talking about some of the reasons for coming to that understanding, and how to use it to improve our health and well-being. I fully expect to spend the remainder of my career showing people how these new laws and principles can help us all, as well as ensuring that appropriate research continues to help us develop these new understandings about health and wellness.

So I’m going to suggest that Ken’s problems might never have happened if he hadn’t been on such a deep spiritual quest, and if he hadn’t been turning up a lot of answers that matter.

August 05, 2006

I’m an extremely frequent flier: in an average year I fly the equivalent of ten to twelve times around the world, or all the way to the moon and part of the way back. So I’ve had to learn all the tricks for surviving countless hours in the air.

Some of them you will know already: keep hydrated, avoid alcohol, move and stretch whenever you can. I’ll soon be posting my jet-lag strategies.

But I wanted to let you know about a product that I’ve been using for years: it’s now called Yarrow Environmental Solution. I’ve certainly found that it’s been very helpful in reducing some of the exhaustion that is a common part of long haul air travel.

There is a piece of unpublished research that seems to confirm that the remedy is having a measurable effect. I wish that I had the time to do a more extensive study to see whether my observations have a scientific basis.

Current scientific models can’t explain how the flower essence could possibly work. Yet my observations and those of many students and patients are that it can be very helpful indeed. Not just to frequent fliers, but also for people who spend a lot of time in front of computer screens or under artificial light.

If you are exposed to any of these things, and find yourself constantly drained and exhausted, you may find this essence very helpful, as part of a package of Integrated Medical care.

Regular readers know that I’m most insistent on full disclosure. So I can reveal that I have absolutely no relationship with the manufacturer, other than buying bottle of their essences.

“The web of our life is of a mingled yarn, good and ill together . . .”--William Shakespeare (English Poet and Dramatist, 1564-1616)

I have a favorite scene in one of my all time favorite movies, Chariots of Fire, in which the China-born Scottish missionary Eric Liddell is told that the world may be ready for a “muscular Christian.”

I’ve spent more than three decades in the company of holistic practitioners, ecologists and other people working toward a better future. But over the years I’ve had many friendly debates with people about the way in which so much of their activities are all about love and peace, turning the other cheek, and activities that I can only describe as “Really, really Yin.”

On one level this is all fine: we live in a world that has spent at least six thousand years extolling the virtues of Yang energy: Action, fight, conquest, domination of women. The list is a long one. And it has got us into a mess. But does that mean that becoming totally Yin is the answer? Yin, the “female energy” that grounds, takes in and stabilizes can really only act in the presence of Yang energy. Whether we are looking at individuals or at the relationships and society that we create, we need to balance the two forces. I worry that the anodyne approach to personal development, that insists that we should all be quiet, passive and yielding, may not be the best approach to balance out our lives to help us help the planet.

“The hottest places in hell are reserved for those who, in times of great moral crisis, maintain their neutrality.”--Dante Alighieri (Italian Poet and Philosopher, 1265-1321)

“Washing one's hands of the conflict between the powerful and the powerless means to side with the powerful, not to be neutral.”--Paulo Freire (Brazilian Educator, 1921-1997)

To use the terminology of spiral dynamics, if we get stuck in the Green Meme, with no spark of the creative, strong Red Meme that gives us thestrength to fight to defend ourselves, how will we getthings done? What will propel us to setting out to perform heroic acts, rather than just staying at home doing the laundry?

In no way am I suggesting that you need to become a violent or aggressive individual. But if you have been moving toward your calm center, the Yin aspect of life, or the Green Meme, how will you be able to help the world in time of crisis? How will you be able to form dynamic relationships based on partnering rather than domination?

Are you living in balance, or have you allowed yourself to be sucked into mawkish New Age sentimentality that may not serve you in times to come?

One of the essential principles of integrated (a.k.a. integrative) medicine, is to re-establish balance in a person's life. Could any problems that you are facing be a result of having your Yin and Yang out of balance? Or your center of gravity being totally located in the Green Meme? Could you have no motivation or energy because you've got out of balance?

I urge you to use intuition and introspection, to seek inner guidance to see if you are missing out on something very important in your life and in your relationships.

“The sage grasps the universe by the arm. He blends everything into a harmonious whole.”--Chuang Tzu (Chinese Philosopher, c.369-286 B.C.E.)

“Unless the wisdom of the East and the energy of the West can be harnessed and used harmoniously, the world will be destroyed.”-- George Gurdjieff (Armenian-born Adept, Teacher and Writer, c.1873-1949)